Five Bullet Friday: Women’s Health January 17, 2019

Happy Friday!

Today’s Five Bullet Friday:

1. A Clarification of Use of Mesh in Gynecological Surgeries from the President of the AAGL

2. NEW Guidelines for Recurrent UTIs, 2019

3. Heavy Menstrual Bleeding Common in Teens and Requires Multidisciplinary Care

4. Weight & Major Psychiatric Disorders Genetically Linked

5. Improve Sleep by Losing Fat from Your Tongue?

Five Bullet Friday: Women’s Health is meant to be a quick, easy to skim resource for you and other health and medical professionals to keep you up to date with all things related to women’s health. My goal for these emails will be to bring to you pertinent and helpful resources for patients (such as short videos or handouts), new research and guidelines, clinical pearls, or anything else interesting related to women’s health! If you’d like to be added to my email list to receive my Five Bullet Friday: Women’s Health, or if you would like suggest particular topics you are eager to hear about, please send an email to cassie@tayloredtraining.ca.

Thank-you, and happy reading!

  1. A Clarification of Use of Mesh in Gynecological Surgeries from the President of the AAGL

President of the American Association of Gynecologic Laparoscopists (AAGL) recently commented on the announcement from the US FDA which recalled transvaginal mesh used for the treatment of pelvic organ prolapsed (POP).

Dr. Fidela Paraiso explained that there is an important distinction that many people aren’t realizing: the FDA recalled surgical mesh for some – but not all – procedures related to pelvic floor disorders, which some media sources are not disclosing that subtlety.

Dr Fidela Paraiso furthers that the mesh itself is not defective and that the recall only applies to repairing of POP. It has not, however, been recalled when the mesh is inserted through an abdominal incision for POP repair, nor mesh used in midurethral sling procedures for the treatment of stress urinary incontinence.

For more details on the difference between the use of mesh for POP repairs and for the treatment of stress urinary incontinence, please see Dr. Fidela Paraiso’s full explanation in the reference below.

Ref: Click here for Link

2. New Guidelines for Recurrent UTIs – 2019

Uncomplicated urinary tract infection is one of the most common indications for antimicrobial exposure in otherwise healthy women. We are obviously concerned with overuse of antibiotics as it has led to drug-resistant organisms in the past 20 years. Because of this, new guidelines were created and published in the Journal of Urology in 2019 to help guide treatment of recurrent UTIs.

Note: recurrent UTIs are defined as two culture-proven UTIs in a 6-month period, or three culture proven events in 1 year. The following guideline is heavily focused on treating not only symptoms, not only cultures, but rather the important combination of symptoms combined with positive cultures. This new guideline is an important step in helping physicians reduce the “collateral damage” or over-prescription of antibiotics to slow the rate of development of antimicrobial resistance.

2019_UTI_Guidelines

Ref: Anger, Jennifer & Lee, Una & Ackerman, Roger & Chou, & Chughtai, Bilal & Clemens, J. & Hickling, Duane & Kapoor, Anil & Kenton, Kimberly & Kaufman, Melissa & Rondanina, Mary & Stapleton, Ann & Stothers, Lynn & Chai, Toby. (2019). Recurrent Uncomplicated Urinary Tract Infections In Women: Aua/Cua/Sufu Guideline. Journal of Urology. 202. 10.1097/JU.0000000000000296.

3. Heavy Menstrual Bleeding Common in Teens and Requires Multidisciplinary Care

The reported prevalence of heavy menstrual bleeding in adolescents ranges from 34% to 37%, authors Dr. Borzutzky and Dr. Jaffray note in their recent paper.

This can lead to anemia, fatigue, and hemodynamic instability which may result in ED visits, hospital stays, the need for transfusion and oral or intravenous therapies to stop blood loss.

Authors say it is important to distinguish the etiology of this in adolescent girls to guide treatment, which can include hemostatic medications, hormonal agents, or a combination of both. They also note that historically the evaluation of heavy menstrual bleeding has been predominately the role of a primary care clinician or gynecologist, but given that a high prevalence of female individuals (specifically adolescents) with heavy menstrual bleeding have underlying bleeding disorders, hematologists should also have a prominent role.

Ref: Borzutzky C, Jaffray J. Diagnosis and Management of Heavy Menstrual Bleeding and Bleeding Disorders in Adolescents. JAMA Pediatr. Published online December 30, 2019. doi:10.1001/jamapediatrics.2019.5040

4. Weight & Major Psychiatric Disorders Genetically Linked

New research shows that there appears to be a robust genetic link between body weight and major psychiatric disorders, an international research team has concluded.

Using data from more than a 500,000 individuals with major depression, bipolar disorder, and schizophrenia, the investigators showed extensive genetic overlap between body mass index (BMI) and psychiatric disorders. Interesting, they found that although the genetic risk variants for major depression and bipolar disorder were primary associated with increased weight, the majority of genetic variants for schizophrenia were related to reduced weight.

Authors found this quite interesting, because essentially this meant that if people had a susceptibility for increased BMI they were also likely to suffer from depression or bipolar disorder, but for schizophrenia it was the opposite: if they were at risk of schizophrenia, they were less likely to be obese. They conclude that increased body weight in schizophrenia seems to be directed mainly by diet, lifestyle, and side effects of mediation, but that it is a completely different picture with bipolar disorder and depression.

Authors further conclude that, “aligned with epidemiological findings, [their] results underscore the importance of considering both metabolic and psychiatric factors when trying to understand and treat mental illness effectively.” They are hopeful that this could lead to more prediction tools and better treatment choices for individuals with severe mental disorders.

Ref: Bahrami S, Steen NE, Shadrin A, et al. Shared Genetic Loci Between Body Mass Index and Major Psychiatric Disorders: A Genome-wide Association Study. JAMA Psychiatry. Published online January 08, 2020. doi:10.1001/jamapsychiatry.2019.4188

5. Improve Sleep by Losing Fat from Your Tongue?

A new study published in the American Journal of Respiratory and Critical Care Medicine just this month discovered that reducing the amount of fat in your tongue improves sleep apnea.

Previous research has shown that obesity is a key risk factor for sleep apnea, and that those who are obese who suffer from the condition tend to have considerably larger tongues with a higher percentage of tongue fat than obese people who do not suffer from sleep apnea.

So, how do you trim down your tongue fat? It comes down to overall body fat loss, the study found. “This study shows reducing excess fat in general can reduce tongue size. [And] the more tongue fat you lost, the more your apnea improved”.

This leads authors to believe that tongue fat is a potential new therapeutic target for improving sleep apnea, and they suggest future studies explore whether certain diets are better than others in reducing tongue fat, and whether cold therapies might be applied to reducing tongue fat.

Ref: Stephen H. Wang, Brendan T Keenan, Andrew Wiemken, Yinyin Zang, Bethany Staley, David B. Sarwer, Drew A. Torigian, Noel Williams, Allan I Pack, Richard J Schwab. Effect of Weight Loss on Upper Airway Anatomy and the Apnea Hypopnea Index: The Importance of Tongue FatAmerican Journal of Respiratory and Critical Care Medicine, 2020; DOI: 10.1164/rccm.201903-0692OC

Five Bullet Friday: Women’s Health January 10, 2019

Happy Friday!

Today’s Five Bullet Friday:

1. Fragmented Sleep May Trigger Migraine 2 Days Later

2. Patient RESOURCE: Back to Basics: 10 Facts Every Person Should Know About Back Pain

3. Pelvic Pain-Focused Interventions Worthwhile after Vaginal Mesh or Mesh Sling Removal

4. The Fuzz Speech: Explaining Fascia and the Importance of Movement

5. Women’s Health RESEARCH Opportunities Local and Online

Five Bullet Friday: Women’s Health is meant to be a quick, easy to skim resource for you and other health and medical professionals to keep you up to date with all things related to women’s health. My goal for these emails will be to bring to you pertinent and helpful resources for patients (such as short videos or handouts), new research and guidelines, clinical pearls, or anything else interesting related to women’s health! If you’d like to be added to my email list to receive my Five Bullet Friday: Women’s Health, or if you would like suggest particular topics you are eager to hear about, please send an email to cassie@tayloredtraining.ca.

Thank-you, and happy reading!

  1. Fragmented Sleep May Trigger Migraine 2 Days Later

A fascinating new study published in Neurology found that people whose sleep is fragmented during the night are at a higher risk of experiencing a migraine episode not the next day, but the day after that.

Authors Dr. Bertishch knew that sleep and migraines have been linked for a long time, both anecdotally and by scientific research, and wanted to look a bit deeper in to their relationship.

What they found that was sleeping for 6.5 hours or under each night, as well as having poor quality sleep, did not correlate with migraine episodes the next day or day following. However, having a fragmented sleep was linked with a 39% higher risk of migraine on the day after the fragmented sleep.

Further research is needed at this time to better understand this low sleep efficiency and migraine correlation going forward.

Ref: Suzanne M. Bertisch, Wenyuan Li, Catherine Buettner, Elizabeth Mostofsky, Michael Rueschman, Emily R. Kaplan, Jacqueline Fung, Shaelah Huntington, Tess Murphy, Courtney Stead, Rami Burstein, Susan Redline, Murray A. Mittleman. Neurology Dec 2019, 10.1212/WNL.0000000000008740; DOI: 10.1212/WNL.0000000000008740

2. Patient RESOURCE: Back to Basics: 10 Facts Every Person Should Know About Back Pain

Low back pain is the leading cause of disability worldwide, and is often associated with costly, ineffective and sometimes harmful care, yet unhelpful patient beliefs about low back pain remain pervasive. This great, free to- the -public resource printed in the British Journal of Sports Medicine outlines 10 facts about our back and back health that everyone should know, especially those who are struggling with back pain.

Find this helpful info graphic along with the rest of the article at the reference below, or see attached to this email.

bjsports-2019-101611-F1.large

Ref: O’Sullivan PB, Caneiro J, O’Sullivan K, et al Back to basics: 10 facts every person should know about back pain British Journal of Sports Medicine Published Online First: 31 December 2019. doi: 10.1136/bjsports-2019-101611

3. Pelvic Pain-Focused Interventions Worthwhile after Vaginal Mesh or Mesh Sling Removal:

Transvaginal synthetic mesh and mesh sling placement for the treatment of stress urinary incontinence and pelvic organ prolapse can yielded adverse outcomes, including pelvic pain and dyspareunia. Pelvic floor physical therapy (and medications and injections as necessary) in compliant patients experience significant improvement of their symptoms, and pelvic pain-focused interventions are a worthwhile recommendation in women with refractory pelvic pain after vaginal mesh or mesh sling removal.

Ref: Abraham, Annie & Scott, Kelly & Christie, Alana & Morita-Nagai, Patricia & Chhabra, Avneesh & Zimmern, Philippe. (2019). Outcomes Following Multidisciplinary Management of Women With Residual Pelvic Pain and Dyspareunia Following Synthetic Vaginal Mesh and/or Mesh Sling Removal. Journal of Womenʼs Health Physical Therapy. 1. 10.1097/JWH.0000000000000140.

4. The Fuzz Speech: Explaining Fascia and the Importance of Movement

This is an older video, but one that I love to share because it is so well done. The Fuzz Speech, but Dr. Gil Hedley, is a fantastic explanation of our fascia, how important movement is, and what can happen to our bodies if we are consistently sedentary. Most patients very much love this video and learn a lot from it. I do say most, however, as Gil does show a cadaver at some point.. so your more squeamish patients may not enjoy the recommendation!

Check out this 5 minute video, here.

5. Women’s Health RESEARCH Opportunities – Local in Kingston, ON and Online

Some amazing and important research is happening right now at Queen’s University in Kingston, Ontario looking at a number of topics including:

  • Psychoscial and Treatment Factors Associated with Persistent Genital Arousal Disorder
  • Biopsychosocial Investigation of Persistent Genital Arousal Disorders in Women
  • Sexual Wellbeing of Women Using SSRIs
  • Sexual Wellbeing of Women Experiencing Depression Symptoms
  • Sexuality and Breast Cancer
  • Sexuality and Menopause

Some studies are available to online participants, while others are in lab. For more details for you or your patients, visit here.

 

Five Bullet Friday: Women’s Health – January 3, 2020

Happy Friday!

Today’s Five Bullet Friday:

1. The Effects of Intermittent Fasting on Health, Aging and Disease – NEW Article in NEJM

2. Explaining Pain to Your Patients – A Physio’s Favourite Resource

3. Urinary and Gynaecological Dysfunctions Common with EDS and Associated Hypermobility Disorders

4. Global Consensus Guidelines on Use of Testosterone in Women (2019)

5. PATIENT HANDOUT: 5 Toileting Mistakes that Could Contribute to Pelvic Floor Dysfunction

Five Bullet Friday: Women’s Health is meant to be a quick, easy to skim resource for you and other health and medical professionals to keep you up to date with all things related to women’s health. My goal for these emails will be to bring to you pertinent and helpful resources for patients (such as short videos or handouts), new research and guidelines, clinical pearls, or anything else interesting related to women’s health! If you’d like to be added to my email list to receive my Five Bullet Friday: Women’s Health, or if you would like suggest particular topics you are eager to hear about, please send an email to cassie@tayloredtraining.ca.

Thank-you, and happy reading!

 

1. The Effects of Intermittent Fasting on Health, Aging and Disease – NEW Article NEJM

In this excellent review article in the New England Journal of Medicine, authors Cabo and Mattson discuss intermittent fasting and its many benefits for humans. They discuss previous nutrition animal studies that assumed that benefits came from calorie restriction, at the time not recognizing that the animals typically consumed their entire daily food allotment within a few hours after its provision, thus meaning they had a daily fasting period of up to 20 hours, during which ketogenesis occurs.

For humans, preclinical studies and clinical trials have shown that intermittent fasting has broad-spectrum benefits for many health conditions, such as obesity, diabetes mellitus, cardiovascular disease, cancers, and neurologic disorders. Positive outcomes from intermittent fasting extend past those of simply restricting calories and the beneficial effects involve metabolic switching and cellular stress resistance.

In this review article, it is recommended that physicians can advise patients to gradually reduce the time window during which they consume food each day with the goal of fasting for 16 to 18 hours a day. They can alternatively recommend another intermittent fasting protocol as outlined in the review.

Reference: De Cabo, R. & Mattson, M. New Engl J Med. 2019; 381: 2541-51. DOI: 10.1056/NEJMra1905136

 

2. Explaining Pain to Your Patients: a Physio’s Favourite Resource

One of my favourite resources to share with patients regarding why they experience pain and what to do about it comes from pain specialists in Australia. Check out the following video “Understanding Pain and What to Do About it in Less Than Five Minutes”

Check out this great resource, here!

 

3. Urinary and Gynaecological Dysfunctions Common with EDS and Associated Hypermobility Disorders

Ehlers-Danlos syndromes (EDS) and associated hypermobility spectrum disorders (HSD) are a group of connective tissue disorders associated with significant morbidity. A recent review suggests that in this population a higher index of suspicion for urorgenital problems is warranted in this population, with urinary, gynaecological and obstetrical complications reported as common.

This information is helpful to encourage early referrals to appropriate disciplines in this population, including pelvic health physiotherapists.

Reference: Gilliam, E, Hoffman, JD, Yeh, G. Urogenital and pelvic complications in the Ehlers‐Danlos syndromes and associated hypermobility spectrum disorders: A scoping review. Clin Genet. 2019; 1– 11. https://doi.org/10.1111/cge.13624

 

4. Global Consensus Guidelines on Use of Testosterone in Women (2019)

A Task Force of representatives of leading societies, whose international memberships include clinicians assessing and managing sex steroid therapy for women, was established in order to create a global consensus position statement on the use of testosterone in women. This Guideline was published in December 2019, it addresses available evidence and states:

  • No cut-off blood level can be used for any measured circulating androgen to differentials women with and without sexual dysfunction
  • There are insufficient data to make any recommendations regarding the use of testosterone in premenopausal women for treatment of sexual function or any other outcome
  • The only evidence-based indication for testosterone therapy for women is the treatment of HSDD, with available data supporting a moderate therapeutic effect, in postmenopausal women
  • There are insufficient data to support the use of testosterone for the treatment of any other symptom or clinical condition, or for disease prevention
Reference: Davis, Susan & Baber, Rodney & Panay, Nicholas & Bitzer, Johannes & Perez, Sonia & Islam, Rakibul & Kaunitz, Andrew & Kingsberg, Sheryl & Lambrinoudaki, Irene & Liu, James & Parish, Sharon & Pinkerton, Joann & Rymer, Janice & Simon, James & Vignozzi, Linda & Wierman, Margaret. (2019). Global Consensus Position Statement on the Use of Testosterone Therapy for Women. The Journal of Clinical Endocrinology & Metabolism. 104. 10.1210/jc.2019-01603.

 

5. Patient Handout: 5 Toileting Mistakes that Could Contribute to Pelvic Floor Dysfunction

Toileting habits are something we don’t often talk about but that can absolutely encourage or exacerbate pelvic floor dysfunctions. See attached to this email a great resource for patient’s talking about common toileting mistakes and what they can do to correct them!

Should you exercise during pregnancy? Yes!

Pregnancy is an incredibly exciting time of life, but it can also be a time where you feel unsure about all of the things you should and should not do. A lot of women who have always been active wonder if they can continue to train the way they have previously, while others who have been more sedentary feel they cannot start anything new as their changing body isn’t yet used to it.

It’s time to clear some things up for you!!

Unless you have a high-risk pregnancy exercise is not only a good idea, it is actually so incredibly important for both your health and the health of your baby!!

Due to all of the misconceptions out there on exercising during and after pregnancy, an Expert Committee from the IOC was formed to specifically look at exercise and pregnancy in both recreational and elite athletes. Their recommendations are as follows:

In absences of maternal or fetal contraindications, exercise prescription in pregnancy includes the same principles and elements used for the non-pregnant population.

BUT it is important or remember and work with someone who understands the changes associated with pregnancy, which the IOC committee list as “significant anatomical, hormonal, metabolic, cardiovascular and pulmonary changes/adaptions.”

What does this mean?

That pregnant women should continue to incorporate exercise (or start to exercise)! In fact, the article continues on to state that there is very strong evidence that strength training both in general and of the pelvic floor muscles during this time can both prevent and treat urinary incontinence during pregnancy and after birth. It is also associated with a shorter first stage of labour.

Are there any signs you should slow down?

The IOC Committee explains that women without contraindications should exercise regularly during pregnancy while being regularly assessed. They indicate the following signs to indicate it may be time to stop exercising:

  • Vaginal bleeding
  • Regular painful contractions
  • Amniotic fluid leakage
  • Dyspnoea (shortness of breath) prior to exertion
  • Dizziness/syncope (fainting)
  • Headache
  • Chest pain
  • Muscle weakness
  • Calf pain or swelling

What about Post-Partum?

The birth of your child is a wonderful moment, but it also can very much impact Mom’s musculoskeletal system, with delivery being likened to an acute sports injury. Therefore, deciding when and how to return to exercise can sometimes be more complex and multifactorial. This is why it is important to seek the help of a pelvic health physiotherapist who can guide you based on your needs and your rehabilitation goals.

The IOC committee encourage exercise in the post-partum period should start gradually with a pelvic floor muscle first focus.

Key Take-Aways:

– Exercise before, during and after pregnancy is so important for both the health of you but also for your baby

– In the absence of high-risk pregnancies, exercise is safe and beneficial as long as the anatomical and physiological changes that mom undergoes are considered

– Monitor your body during exercise and be followed/assessed regularly by a skilled coach or practitioner who is experienced in working with pre and post-natal clients.

– Begin exercise post-partum slowly and under the guidance of a professional who can help you take a pelvic floor first approach to strength training

Find this awesome research article, here.

And to find out more about exercise during pregnancy, follow the amazing @coach_vanessagiguere on instagram (she is the one above in the photo, rocking the prowler while in her third trimester!)

Wearing High Heels Could Make Your Incontinence Worse

Wearing High Heels Could Make Your Incontinence Worse

Our pelvic health is so incredibly important to our overall health and thankfully this fact is starting to get more and more recognition with more resources and research focusing on improving this aspect of women’s health.

Pelvic floor dysfunctions such as incontinence, pelvic organ prolapse, pelvic pain and low back pain are incredibly common among women (both who have had children and who have not), but they are NOT normal. In other words, there is SO much we can do to prevent and treat these dysfunctions so you can feel and move your best!

And I’m not just talking about doing Kegels. In fact, did you know that there is so many more factors to consider when it comes to our pelvic health than just training the muscles of the pelvic floor?

One of these factors is what I want to talk about today – a particular habit that can affect how your pelvic floor functions: wearing high heels.

A recent study just published earlier this year looked at the effect of certain ankle positions on the resting and maximal contraction of the pelvic floor muscles. In other words, they looked to see if there was a difference in pelvic floor muscle activity when someone was in a neutral ankle position (ie flat foot), in a plantar flexed ankle position (ie in high heels) or in a dorsi flexed ankle position (ankle flexed up).

So, let’s dive in to the study and see what the effects of wearing high heels are on your pelvic floor!

The rationale for the study:

When looking at urinary continence it is important to understand that the pelvic floor muscles form a major component of what’s called the uretrhal support system. They provide this urethral support by maintaining the constant muscle tone necessary to support the bladder neck and keep the urethral closure closed both at rest and during episodes of increased pressure (such as during a sneeze).

The Pelvic Floor muscles maintain a constant muscle tone that is necessary to keep you continent.

Previous studies have shown us that the activity of the pelvic floor muscles will change based on different body positions or postures, such as sitting, standing, or in varying degrees of pelvic tilts.

Other studies have shown that wearing high-heels will significantly change your biomechanics, posture and the way you walk, and armed with this information this study sought to determine if there would be a difference in muscle activity wearing high heels (ie plantar flexed ankle position) vs in a neutral or dorsi flexed ankle.

The Results

Authors of the study determined that there is significantly more muscle activity in the pelvic floor at rest when the ankle is in a neutral or dorsi flexed position as compared to a plantar flexed position.

This means that your pelvic floor muscles have a better ability to work and support your bladder and to keep you continent when in these positions, versus when you are wearing high heels.

Authors also determined that women had a maximal pelvic floor contraction (aka Kegel) that was much stronger when they were in the neutral or dorsi flexed positions vs in the plantar (high heel) flexed position. In other words, they were able to better consciously contract their pelvic floor when they weren’t wearing high heels.

Why this is important

The results of this study show us that women who experience pelvic floor symptoms such as stress incontinence could experience worse symptoms when wearing high heels due to the decreased support of the pelvic floor muscles in the urethral support system.

This means that women who experience leaking throughout the day could potentially improve their symptoms by opting for flatter shoe choices.

Just another reason to limit the amount of time you spend in high heels and to visit a pelvic health physiotherapist who can help you to ensure that your pelvic floor muscles are functioning as optimally as possible!

Wearing high heels leads to less activity of the pelvic floor which could mean more leaking.

Check out the study, here.

Prolonged Sitting and Low Physical Activity can Increase Urinary Tract Symptoms

At this point most of us have heard multiple messages talking about the importance of daily physical activity and the importance of avoiding prolonged sitting for our health, but more and more studies are coming out showing us just HOW critical these things are in ALL aspects of our health!

A recent study published just four days ago decided to look at the association of sitting time and physical activity level on the incidence of lower urinary tract symptoms.

Results? 

Both prolonged sitting time AND low physical activity level were independently associated with lower urinary tract symptoms. In other words, individuals who sat for long periods of time (even if they were physically active otherwise) had increased symptoms, as did individuals who participated in low physical activity (even if they did not sit for long periods of time).

This is just yet ANOTHER reason to ensure you are including movement and exercise in your daily lifestyle!

How do you do this?

If you are someone who works at a desk all day, find a reason to get up frequently! Use a very small water bottle so you have to get up frequently to go fill it. Take every phone call walking around your office instead of sitting in your chair. Change positions frequently throughout the day. Find what works for you, but get up and move to avoid those periods of prolonged sitting.

And otherwise, work with a coach who can help guide you on how to best incorporate physical activity in to your day!

For link to the study, click here!

Can’t do a Kegel Properly? We can help with that.

There is incredibly strong scientific evidence that shows Pelvic Floor Muscle Training (PFMT) is a fantastic and effective form of treatment for many pelvic floor dysfunctions, including urinary incontinence or pelvic organ prolapse. However, all of the research that has studied this is performed using participants who are able to correctly and voluntarily contract their pelvic floor. And of course, you need to be able to properly contract the pelvic floor if you want to train it and see positive results!

The problem with this?

Only about 50% of women are able to properly contract their pelvic floor!

In other words, 1 in 2 women cannot perform a proper ‘Kegel’, even with written or verbal instruction, with common errors including contraction of other muscles (abdominals, gluteals, adductors), pelvic movements, breath holding and straining.

So, how can we ensure that these women can effectively train their pelvic floor muscles and reap the enormous benefits associated with PFMT?

Enter Physiotherapy.

A brand new research study is currently in press which looked at three different approaches to best teach how to do a proper pelvic floor muscle contraction in order to then strengthen the muscles.

The study, published here, had four groups:

  1. A control group who received only written and verbal instruction on how to properly perform a contraction
  2. A group that used intravaginal electrical stimulation (where an external electrical impulse creates a muscle contraction)
  3. Vaginal palpation (where a trained physiotherapist facilitated a contraction via hands-on palpation of the muscle)
  4. Vaginal palpation with an added posterior pelvic tilt

 

What they Looked at:

Researchers looked primarily at the ability of the participants to properly perform a pelvic floor muscle contraction (measured by using what is called the MOS scale – the way physiotherapists measure the strength of a muscle), and then secondarily at whether or not urinary incontinence was improved. Participants were then placed in one of the four above groups for eight weeks.

Results?

Though all groups did improve with urinary incontinence, vaginal palpation with or without the posterior pelvic tilt was the most effective intervention for facilitating voluntary PFM contraction in women compared with electrical stimulation or a control group!

What does this mean?

When you have a trained physiotherapist work with you when you aren’t able to properly engage your pelvic floor muscles they can use hands-on techniques – including vaginal palpation – to create a proprioceptive stimulus that makes it much easier to learn how to properly engage the muscles and facilitate a correct contraction of the pelvic floor.

How does this work?

Simply put, the hands on aspect of working with a physiotherapist helps your neuromuscular system to adapt through what is called motor learning. In other words, by having that proprioceptive stimulus together with practice and feedback from your therapist, changes in your central nervous system occur which results in the production of a new motor skill: aka, the ‘Kegel’!

Once these neuromuscular adaptions occur, you can then participate in PFMT to work on the strength, endurance, and coordination of your pelvic floor and benefit from the many positives of doing so!

Moral of the Story?

Physiotherapy is an incredibly important part of women’s and pelvic health. We know pelvic floor dysfunctions can be treated and prevented with proper pelvic floor muscle training, but in order to be able to complete this training it is essential that women are able to properly contract their pelvic floor.

Physio can help.

Article Highlights:

  • Training the pelvic floor muscles is essential for the treatment of pelvic floor dysfunctions

  • However, nearly 50% of women cannot properly perform a pelvic floor muscle contraction, or ‘Kegel’ even with verbal or written instructions

  • Working with a physiotherapist who utilizes hands on vaginal palpation with or without other treatment methods improves learning and facilitates proper pelvic floor muscle contractions